A conceptual framework for the revision of the ICD‐10 classification of mental and behavioural disorders

Following the development of ICD-11 through World Psychiatry (and other sources).

Towards innovative international classification and diagnostic systems: ICD‐11 and person‐centered integrative diagnosis

Prototype diagnosis of psychiatric syndromes and the ICD-11

Notes of a traveller

Proposals for ICD-11: a report for WPA membership.

The World Health Organization (WHO)'s priorities for the development of the classification of mental and behavioural disorders in the ICD-11 include increasing its clinical utility in global mental health settings (1) and improving the identification and diagnosis of mental disorders among children and adolescents (2). An issue that has been hotly debated in the area of childhood psychopathology is the assessment, diagnosis and treatment of children with severe irritability and anger (3,4). Although virtually all children display irritable and angry behaviours at times, some children exhibit them more frequently and more intensely, to the extent that they become an impairing form of emotional dysregulation. Recent findings indicate that these children with chronic and severe irritability/anger have not been adequately identified through existing classification systems, are at an increased risk for particular negative outcomes, and have not received appropriate treatment. To the extent that ICD-11 can help clarify the clinical picture of irritability/anger, children and families will benefit from more accurate diagnoses, more useful prognoses, and more effective interventions. This paper provides a brief overview of the issue, followed by several possible options and the current proposal for the classification of childhood irritability/anger in ICD-11. This proposal represents a markedly different – but we believe more scientifically justifiable – solution to the problems in this area than that selected for DSM-5 (5).

Within the 16th World Congress of Psychiatry, held in Madrid from 14 to 18 September 2014, a series of symposia took place, providing information on the ongoing development of the chapter on mental disorders of the ICD-11. The symposia summarized the proposals for the various sections of the chapter, which are being produced by the fourteen working groups appointed by the World Health Organization (WHO) in consultation with relevant stakeholders, including WHO's member countries, several professional groups, and users of mental health services and their families. A list of scientific papers presenting and discussing these proposals, and of other relevant publications, is provided at the end of this article (1–99). The symposia also presented the field studies for the development of the ICD-11 chapter on mental disorders, which can be subdivided into three groups: formative field studies, Internet-based field studies, and clinic-based field studies. Formative field studies aimed to guide decisions about the basic structure and content of the classification, exploring clinicians' conceptualizations of the interrelationships among categories of mental disorders. In the first study (100), 1,371 psychiatrists and psychologists from 64 countries rated the similarity between mental disorders presented as paired comparisons. The results indicated that the participants' mapping of mental disorders was remarkably consistent across professions, languages and WHO regions. The degree of similarity between clinicians' views and the structures provided by the DSM-IV and ICD-10 was moderate (kappa + .42). The proposed structure for ICD-11 was found to more closely align with clinicians' understanding of the relationships among disorders (kappa + .51). In the second study (101), 517 mental health professionals recruited by field study centres in eight countries were asked to sort a set of 60 cards containing the names of mental disorders, based on their own clinical experience, and then to form a hierarchical structure by aggregating and disaggregating these groupings. The hierarchical organizations produced by clinicians were remarkably consistent across countries, diagnostic systems currently used and professions. Clinicians' consensus classification structure was different from ICD-10 and DSM-IV and in several respects consistent with proposals for ICD-11. Internet-based field studies are being implemented through the Global Clinical Practice Network, which currently includes about 12,000 practitioners from all regions of the world. Physicians, primarily psychiatrists, represent 59% of the Network, and psychologists 30%. All other mental health disciplines (e.g., nursing, social work and occupational therapy) are also represented. One third of the members are from Asia, one third from Europe, and 20% from the Americas, equally divided between Latin and North America. About 41% come from low- or middle-income countries. Members have registered through nine languages (Arabic, Chinese, English, French, German, Japanese, Portuguese, Spanish and Russian). These Internet-based studies are using vignette methodologies to examine clinical decision-making in relationship to the proposed ICD-11 diagnostic categories and guidelines. Data collection has been completed for the first study, dealing with disorders specifically associated with stress, which has been conducted in English, Japanese and Spanish with the participation of 1,738 Network registrants. Clinic-based studies will assess the clinical utility of proposed ICD-11 diagnostic guidelines in real-life settings, with a special focus on low- and middle-income countries. More specifically, the studies will assess: the ability of the diagnostic categories to aid clinicians' understanding of the person's condition; how well the guidelines fit the presentation of actual clinical cases; the feasibility of using the guidelines in regular clinical interactions; and the adequacy of the guidelines for assessing individuals' conditions. A major multi-country study has also been conducted concerning the utility and reliability of key changes being recommended for the primary health care version of the ICD-11 chapter on mental disorders. This study focused on the most common mental disorders seen in primary care settings (in particular, depression, anxiety and somatic symptoms).

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Letter to the Editor: EDUCATIONAL ACTIVITIES RELATED TO THE ICD-11 CHAPTER ON MENTAL DISORDERS.

Letter to the Editor: CONVERGENCES AND DIVERGENCES IN THE ICD-11 VS. DSM-5 CLASSIFICATION OF MOOD DISORDERS.

Child psychiatry in China: Present situation and future prospects.

Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version

As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children, including the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R; ZERO TO THREE, 2005), a diagnostic classification for mental health symptoms and disorders in infants, toddlers, and preschoolers. We briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Last, we review the limitations of current approaches to the diagnostic classification of mental health disorders in young children.

This article describes the current revision by the World Health Organization (WHO) of the International Classification of Diseases and Related Health Problems (ICD-10). ICD-10 is the basis for ICD-10-CM, which will be introduced in 2013 as the official U.S. system. U.S. psychologists will be required to use ICD-10-CM for all third-party billing and reporting, but are generally not familiar with the ICD or WHO’s role in global health classification. Although the U.S. lags behind other countries on the implementation of WHO’s international classification systems, psychologists and other health professionals will be affected by ICD-11, so it is important to understand its development. WHO views the current revision as an important opportunity to improve the clinical utility of the classification system for mental disorders. Serious problems with the clinical utility of both the ICD and the DSM are widely acknowledged. Clinical utility affects the daily lives of practitioners and is also a global public health issue. Most people with mental disorders worldwide receive no treatment. A diagnostic system with greater clinical utility can be a tool to improve identification and treatment, helping WHO member countries to reduce the disease burden of mental disorders. Consistent with this goal, WHO’s revision process is global, multilingual, and multidisciplinary and will produce different versions of the classification for clinical use, research, and primary care. A systematic program of studies being undertaken by WHO aimed at improving clinical utility is described.

Substance Abuse-Related Mortality Among Middle-Aged Male VA Psychiatric Patients